个别正常成人上前牙美学区唇、腭侧骨板厚度测量分析

Measurement and analysis of the labial and palatal bone thickness of the maxillary anterior(esthetic zone) teeth in Chinese adults with individual normal occlusion

目的：测量分析国人个别正常成人上前牙美学区唇、腭侧骨板厚度,为口腔种植手术,尤其是即刻种植的术前分析、方案制定提供数据支持,并为构建数据库奠定基础。方法：应用KaVo 3D eXam CBCT机对符合纳入标准的60例受试者进行锥形束CT（CBCT）扫描,所得Dicom格式三维重建数据导入InVivo 5软件,测量垂直于牙体长轴L3、L6、L9、L12水平处相应唇、腭侧骨板厚度,所得数据应用SPSS 18.0软件包进行95%参考值范围、频率、配对样本t检验、独立样本t检验、方差分析及多重比较。结果 ：在各牙位各参考线水平,唇侧骨板厚度均较腭侧薄（P〈0.05）,唇侧骨板较多出现小于1 mm及骨板缺如的情况（40.6%~93.1%）,腭侧骨板厚度普遍大于2 mm（L6及以上水平：60%~100%）;左右同名牙、同牙位唇腭侧、性别、年龄段、同参考线不同牙位、同牙位不同参考线间骨板厚度存在差异。结论：上前牙区种植时常存在骨量不足情况,以侧切牙处尤为明显;唇侧骨板厚度较腭侧更薄,且常存在凹陷。种植手术时应在CBCT指导下,适当偏腭侧植入,必要时应用自体骨移植以及骨替代材料、骨劈开、骨增量技术,保证唇侧骨壁的完整性及足够的骨板厚度。

PURPOSE： To measure and analyze the labial and palatal bone thickness of the maxillary anterior（esthetic zone） teeth in Chinese adults with individual normal occlusion, in order to lay a foundation for database and to provide data support and references for preoperative analysis and plan making of implant surgery, especially immediate implantation. METHODS： Sixty subjects who met the inclusion criteria were scanned by Ka Vo 3D e Xam CBCT（conebeam computed tomography）. The three-dimensional reconstruction CBCT data in a Dicom（digital imaging and communication in medicine）format were imported to In Vivo 5 software. The data obtained from the measurement of the labial and palatal bone thickness on reference lines（which were perpendicular to tooth long axis） L3, L6, L9, L12 were statistically analyzed with 95% reference range, frequency, paired sample t test, independent sample t test, ANOVA（analysis of variance）and multiple comparison using SPSS 18.0 software package. RESULTS： The data showed that the mean labial bone thicknesses were less than the corresponding palatal bone on every reference line of each tooth（P〈0.05）,bone absence or thickness less than 1 mm often occurred at the labial bone（40.6%~93.1%）, the palatal bone thicknesses were generally more than 2 mm（L6 and upper levels： 60%~100%）, and there were diversities of bone thickness between left and right teeth, labial and palatal plate, gender, ages, different teeth positions at same reference line, and different reference lines at same tooth position. CONCLUSIONS： Bone is often insufficient at the maxillary anterior teeth when implanting, particularly at the lateral incisors. The labial bone plates are thinner than the palatal bone and frequently exhibit depression. In order to ensure intact labial bone wall and enough bone thickness, the implants should be placed appropriately palatally after measuring and analyzing with CBCT. Moreover, the bone substitute materials, bone splitting and bone augmentation technique should be applied when necessary.